Reply To: hyponautremia
I have answered below your questions below:
So the sodium is both lost through urine with diuresis and diluted by water being drawn into vasculature from intersitital fluid. Does that mean we shouldnt worry as the body as the sodium, just not in the extracellular space?
There will be electrolyte losses in the urine. When animals are significantly hyperglycaemic, a big effect will come from fluid being drawn into the intravascular space. Overall this is a dilutional effect so we need to worry less about body sodium overall.
Insulin will also cause hypokalemia- because it shifts potassium into the cells. which is why insulin is given with potassium supplementation? but is also potassium lost through increased diuresis? i get abit confused here as diabetics is said to be hyperkalemic due to lack of insulin, but then they have increased diuresis with the hyperglycemia as well.
Again, electrolytes will be effected by the diuresis, but there are more significant effects going on in the body. The potassium will be normal when DKA patients are first diagnosed as the acidosis will also have an effect. The increase in H+ will cause potassium to move extracellularly. Basically the movement of potassium in and out of cells is much more significant that the effect the diuresis has.
Hope that helps.